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Mortality in Patients Hospitalized for COVID-19 vs Influenza in Fall-Winter 2023-2024 | Coronavirus (COVID-19) | JAMA | 西瓜视频

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Table 1. 聽Characteristics of the Seasonal Influenza and COVID-19 Groups Before and After Propensity Score Weighting
Table 2. 聽Risk of Death in People Hospitalized for COVID-19 Compared With Seasonal Influenza and in Those Hospitalized for COVID-19 Before vs During the JN.1-Predominant Era
1.
Xie 聽Y锘, Bowe 聽B锘, Maddukuri 聽G锘, Al-Aly 聽Z锘. 聽Comparative evaluation of clinical manifestations and risk of death in patients admitted to hospital with covid-19 and seasonal influenza: cohort study.聽锘 听叠惭闯. 2020;371:m4677. doi:
2.
Cates 聽J锘, Lucero-Obusan 聽C锘, Dahl 聽RM锘, 聽et al. 聽Risk for in-hospital complications associated with COVID-19 and influenza鈥擵eterans Health Administration, United States, October 1, 2018-May 31, 2020.聽锘 聽MMWR Morb Mortal Wkly Rep. 2020;69(42):1528-1534. doi:
3.
Xie 聽Y锘, Choi 聽T锘, Al-Aly 聽Z锘. 聽Risk of death in patients hospitalized for COVID-19 vs seasonal influenza in fall-winter 2022-2023.聽锘 听闯础惭础. 2023;329(19):1697-1699. doi:
4.
Centers for Disease Control and Prevention. COVID data tracker. Accessed February 23, 2024.
5.
Centers for Disease Control and Prevention. COVID-19鈥揳ssociated hospitalizations. Accessed February 23, 2024.
6.
Centers for Disease Control and Prevention. Influenza Hospitalization Surveillance Network (FluSurv-NET). Accessed February 23, 2024.
Research Letter
May 15, 2024

Mortality in Patients Hospitalized for COVID-19 vs Influenza in Fall-Winter 2023-2024

Author Affiliations
  • 1Clinical Epidemiology Center, VA St Louis Health Care System, St Louis, Missouri
JAMA. 2024;331(22):1963-1965. doi:10.1001/jama.2024.7395

In the first year of the COVID-19 pandemic, risk of death in people hospitalized for COVID-19 was substantially higher than in people hospitalized for seasonal influenza.1,2 The risk of death due to COVID-19 has since declined. In fall-winter 2022-2023, people hospitalized for COVID-19 had a 60% higher risk of death compared with those hospitalized for seasonal influenza.3 New variants of SARS-CoV-2 have continued to appear, including the emergence of JN.1, the predominant variant in the US since December 24, 2023.4 This study evaluated the risk of death in a cohort of people hospitalized for COVID-19 or seasonal influenza in fall-winter 2023-2024.

Methods

Based on US Department of Veterans Affairs electronic health records from all 50 states, we identified people who were admitted to the hospital with a diagnosis of COVID-19 or seasonal influenza between October 1, 2023, and March 27, 2024, and within 2 days before and 10 days after a positive test result for SARS-CoV-2 or influenza. Patients with either infection hospitalized for another reason or those hospitalized for both COVID-19 and seasonal influenza were excluded. The cohort was followed up for 30 days, until death, or until March 31, 2024. Baseline characteristics between patients hospitalized for COVID-19 vs influenza were compared using absolute standardized differences; a standardized difference less than .01 suggests good balance.

We adjusted for differences in baseline characteristics between the groups using inverse probability weighting. Logistic regression was used to calculate a propensity score (probability of being assigned to the COVID-19 group) that was then applied to balance the 2 groups; covariates are listed in Supplement 1. Weighted Cox survival models were used to estimate the difference in risk of death between COVID-19 and seasonal influenza groups. Results were reported as adjusted death rates and hazard ratios (HRs) with 95% CIs in the COVID-19 group compared with the seasonal influenza group.

We also examined the difference in risk of death between people hospitalized for COVID-19 before and during the JN.1-predominant era (before vs on or after December 24, 2023). Analyses were performed with SAS Enterprise Guide version 8.3 (SAS Institute Inc). We defined statistical significance as a 95% CI that did not cross 1.00. The study was approved with a waiver of informed consent by the VA St Louis Health Care System Institutional Review Board.

Results

The cohort included 8625 participants hospitalized for COVID-19 (unadjusted death rate, 5.70% at 30 days) and 2647 participants hospitalized for seasonal influenza (unadjusted death rate, 3.04% at 30 days). The COVID-19 and seasonal influenza groups were balanced after propensity score weighting (Table 1).

Patients hospitalized for COVID-19 had a higher risk of death compared with those hospitalized for seasonal influenza (adjusted death rate, 5.70% vs 4.24% at 30 days; adjusted HR, 1.35 [95% CI, 1.10-1.66]). There was no statistically significant difference in the risk of death among people hospitalized for COVID-19 before and during the JN.1-predominant era (adjusted death rate, 5.46% vs 5.82% at 30 days; adjusted HR, 1.07 [95% CI, 0.89-1.28]) (Table 2).

Discussion

The study found that in fall-winter 2023-2024, the risk of death in patients hospitalized for COVID-19 was greater than the risk of death in patients hospitalized for seasonal influenza. Compared with a study using the same database and methods,3 the death rate at 30 days was 5.97% in 2022-2023 vs 5.70% in 2023-2024 for COVID-19 and 3.75% in 2022-2023 vs 4.24% in 2023-2024 for influenza. Both adjusted HRs were statistically significant, with an HR of 1.61 in 2022-2023 and 1.35 in 2023-2024, with overlapping 95% CIs. Changes in either the SARS-CoV-2 or influenza viruses or in their care (eg, use of vaccines or antivirals) may influence the comparative risk of death each season. The findings should be interpreted in the context of nearly twice as many hospitalizations for COVID-19 compared with seasonal influenza during 2023-2024.5,6

The results also showed that at the level of statistical power available in this study, there was no significant difference in risk of death among those hospitalized for COVID-19 before and during the JN.1-predominant era鈥攕uggesting that JN.1 may not have a materially different severity profile than the variants that immediately preceded it.

Study limitations include that the Veterans Affairs population (older age and predominantly male) may not represent the general population and causes of death were not examined.

Section Editors: Kristin Walter, MD, and Jody W. Zylke, MD, Deputy Editors; Karen Lasser, MD, MPH, Senior Editor.
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Article Information

Accepted for Publication: April 10, 2024.

Published Online: May 15, 2024. doi:10.1001/jama.2024.7395

Corresponding Author: Ziyad Al-Aly, MD, VA St Louis Health Care System, 915 N Grand Blvd, 151-JC, St Louis, MO 63106 (ziyad.alaly@va.gov; zalaly@gmail.com).

Author Contributions: Dr Al-Aly had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Al-Aly, Xie.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Al-Aly, Xie.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: All authors.

Obtained funding: Al-Aly.

Administrative, technical, or material support: Al-Aly.

Supervision: Al-Aly.

Other - visualization: Choi.

Conflict of Interest Disclosures: Dr Al-Aly reported receiving grants from US Department of Veterans Affairs during the conduct of the study. Dr Xie reported receiving personal fees from Guidepoint outside the submitted work. No other disclosures were reported.

Funding/Support: This research was funded by the US Department of Veterans Affairs (Dr Al-Aly).

Role of the Funder/Sponsor: The funders of this study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The contents do not represent the views of the US Department of Veterans Affairs or the US government.

Data Sharing Statement: See Supplement 2.

References
1.
Xie 聽Y锘, Bowe 聽B锘, Maddukuri 聽G锘, Al-Aly 聽Z锘. 聽Comparative evaluation of clinical manifestations and risk of death in patients admitted to hospital with covid-19 and seasonal influenza: cohort study.聽锘 听叠惭闯. 2020;371:m4677. doi:
2.
Cates 聽J锘, Lucero-Obusan 聽C锘, Dahl 聽RM锘, 聽et al. 聽Risk for in-hospital complications associated with COVID-19 and influenza鈥擵eterans Health Administration, United States, October 1, 2018-May 31, 2020.聽锘 聽MMWR Morb Mortal Wkly Rep. 2020;69(42):1528-1534. doi:
3.
Xie 聽Y锘, Choi 聽T锘, Al-Aly 聽Z锘. 聽Risk of death in patients hospitalized for COVID-19 vs seasonal influenza in fall-winter 2022-2023.聽锘 听闯础惭础. 2023;329(19):1697-1699. doi:
4.
Centers for Disease Control and Prevention. COVID data tracker. Accessed February 23, 2024.
5.
Centers for Disease Control and Prevention. COVID-19鈥揳ssociated hospitalizations. Accessed February 23, 2024.
6.
Centers for Disease Control and Prevention. Influenza Hospitalization Surveillance Network (FluSurv-NET). Accessed February 23, 2024.
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